Each day countless numbers of X-rays are performed for medical diagnostic purposes. Unfortunately, as the practice of medicine has become increasingly specialized, these X-rays are interpreted by radiologists, who are also physicians, but who have not seen, nor examined the patient. The X-ray is normally taken by an X-ray technician and the X-rays are subsequently reviewed by the radiologist for interpretation and diagnosis. The radiologist normally relies on a cursory written comment from the examining physician on the need for the X-ray so that he will know where to focus his attention. These brief comments might characteristically be in a form such as "trauma to forearm" or "puncture wound to elbow". This method of inadequate communication between the examining physician and the radiologist has led to occasional errors in the reading of film, with subsequent medical consequences.
A recent study by David R. Milne, which appeared in the June 1982 issue of "Emergency Department News" on page 3, cites discordant interpretation of X-rays between radiologists and emergency physicians in 50 to 514 X-rays. In one day, for example, in a prominent medical center within Los Angeles County, two such fractures were initially missed by the radiologist. In each case the examining physician, knowing the exact point of tenderness by examination, was able to point out otherwise questionable lesions to the radiologist who with further views of the affected extremity, or with localized magnification, could identify the fracture. In these instances, no serious harm was done, but the patients had to be transferred back and forth between the doctor's office and the X-ray department until the exact nature of the injury was clarified.
Such incorrect radiographic interpretations have resulted in the following:
1. Missed lesions, such as fractures, with resultant inadequate treatment.
2. Excessive attempts at clarification of areas of questionable radiographic significance, but of no clinical significance, resulting in increased radiation, cost and discomfort to the patient.
3. Loss of time in critical situations, resulting from the need to repeat X-rays.
In order to locate tender areas, or entry sites in the case of puncture wounds, solid radiopaque members have sometimes been included in X-ray photographs. Thus, in some cases, markers are placed on the film itself to indicate entry sites for a puncture wound. In addition, in some rare instances, paper clips have been taped to a patient to indicate more clearly the location of an area requiring special attention. However, the placing of solid objects on the X-ray film itself leaves much to be desired, as the three dimensional positioning of the marker is not possible. In addition, in the rare instances where a solid element such as a paperclip has been taped to a patient, the change in orientation or the bending of the portion of the body for different X-ray positioning configurations, can result in movement of the solid member, or shifting of this member in its position, thereby defeating its purpose. Furthermore, since placing markers directly onto the film can only be done at the time of filming when only the X-ray technician who shoots the picture is present, and since this technician does not have the expertise to determine the area of concern, significant misrepresentation may occur.
Accordingly, a principal object of the present invention is to provide improved communication between the emergency physician, or the initial examining physician, the X-ray technician, and the radiologist, and to focus attention on the areas which have been determined by the examining physician to be tender or to otherwise deserve special attention. A more specific object of the present invention is to satisfy the radiologist's need for a more accurate radiographic localization of a patient's clinical complaint, thus hopefully minimizing discrepancies in the reading of X-ray film.